Colorectal cancer risk factors in north-eastern Iran: A retrospective cross-sectional study based on geographical information systems, spatial autocorrelation and regression analysis

Colorectal cancer (CRC) is the second most common cancer among females and the third most common malignancy in males in the world. No single risk factor has been identified, but there are many interrelated factors that together cause the disease. This retrospective, cross-sectional study aimed to identify potential spatial factors contributing to its geographical distribution. Data concerning 1,089 individuals with CRC from the Khorasan-Razavi Province in Iran, located in the North-East of the country, were obtained from the national CRC registry. Local Moran's I statistic was performed to identify clustered areas of CRC occurrence and ordinary least squared regression was calculated to predict frequency of the disease based on a set of variables, such as diet, body mass index (BMI) and the proportion of the population ‰¥50 years of age. Some dissimilarities related to the geography in the province and also some neighbourhood-related similarities and dissimilarities of CRC occurrence in the city of Mashhad were found. A significant regression equation was found (F (4,137)=38.304, P<.000) with an adjusted R² of 0.6141. The predicted CRC frequency was -58.3581 with the coefficients for average BMI=+1.594878; fibre intake=-0.610335; consumption of red meat +0.078970; and ‰¥50-year age group =+0.000744. All associations were statistically significant, except the consumption of red meat one. The study results illuminate the potential underlying risk factors in areas where the CRC risk is comparatively high and how the CRC risk factors may play a role in CRC geographic disparity. Further research is required to explain the patterns observed. We conclude that people should include more fibre in their daily diet and decline their BMI to decrease risk of CRC.